Site to raise awareness for Charcot Marie Tooth. Discuss my quest to run the Boston Marathon while having CMT. Talk about training and doing marathons, half marathons, triathalons and duathalons. Discuss being an athlete with a disability.

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Thursday, October 31, 2013

Sometimes the key to being successful starts with just
showing up. That was true for me on Saturday when I raced at the National
Duathlon Sprint Championship in Oro Valley, Arizona.

The race was a late season entry to my racing schedule. A
college friend lives in Phoenix and was home for a wedding this summer, but was
unable to stay to visit me. She suggested I come to Phoenix instead. I promised
I would soon and a few days later saw an announcement from the USAT about the
race. So I signed up since it was a good excuse for a visit and I would extend
my season just a bit. What’s not to like about Arizona in late October?

Before I even got to the race I had a couple of decisions to
make.

Bike
Would I rent? Have my bike shipped or
take it on the plane for the trip? I have a bike bag for taking my bike on the
plane and used it to go to Austin this May.
Flying with a bike is a hassle and can be expensive. Even though my bike bag looks like a suitcase
and is fairly small, it can cost as much as $125 each way. Plus it costs around
$50 each time the bike is taken apart and assembled, adding another $200 to the
cost. I‘ve taken my bike apart, after a
race and assembled it again, but my bike mechanic skills are pretty slim. I found out in Omaha at a pre-race bike check
my handlebars were loose after I had assembled the bike. So I did not want to
trust my skills before a big race.

I could use a service like Tri Bike Transport. You drop off
your bike at a local participating bike shop and it is shipped fully assembled
to the race site for pick-up. The
company was not transporting from my region and the cost for doing this for
Iron Man Arizona is $500. They will ship
the bike back, but it can take 7-10 days and I needed my bike a few days after
the race for comp trainer class here in Milwaukee. So this was not really an
option for this race.

I could’ve had the bike shipped to the race site for Tri
Bike Transport to assemble, but that meant finding a box and shipping to the
host resort in Arizona. I did not want to chance the bike getting lost or
damaged.

Tri Sports the race sponsor was offering high performance
bike rentals, but seemed to be sold out of every model in my size.

I called around and was able to find a bike rental at Trek
Bikes of Oro Valley. They were only a couple of miles from the race start and
were an economical option at $85. The
bike was not entry level, but was not as nice or as fast as the road racing
bike I own. I knew I would sacrifice performance for convenience and cost.

RaceThe next big decision I had to make was about the race itself. There were
four divisions at the event, Standard (Age Group & Elite) and Sprint (Age
Group, Para-duathlon).

The Age Group Standard and Sprint races were qualifiers for
the World Championship in Pontevedre, Spain.
The top 18 in each age group qualify for Team USA and are eligible for
the World Championship.

An email from the USAT asked us to confirm our registration
and that we were in the appropriate age group. I was listed with the age group
sprinters and I noticed there were only
13 women in my age group. Because of age up rules only nine would be in
contention for the 18 spots. If I
finished the race I would be on the U.S. team and going to Spain. It was just one of those things. Most of the
age groups had well over two dozen participants. When I raced as an age group
athlete at the Triathlon Nationals in
Milwaukee this year, there were 44 women in my age group.

I had signed up to race as a para-duathlete. Based on last year’s times, I was pretty sure
I would place in the top three, maybe even first. There would be no medical classification at
the event which meant I had to race the Open Division. While it was possible I
could be the Open Division National Champion, there would be no spot on Team
USA or eligibility for the World Championship.

I had already won an Open Division Championship in Austin
two years ago. What I really wanted was a chance for the US team and a chance
to go to the World Championship. Even if I had raced in my category (TRI 3) and
won I was not guaranteed a spot. All
Para-athletes have to apply and be selected based on their race resume. While I
have an impressive resume from this year, because I am not classified I cannot
even apply.

The classification process is being re-done and will be in
place for the Para-triathlon National Championship in May, too late for this
year’s World Championship. It is
possible I will never classify in. The assessors’ do not seem to understand how
to assess for CMT. The ITU and USAT have
not really been interested in talking to our experts, so I don’t’ have much
hope. They have been dismissive in emails about my situation and that of other
CMT affected athletes.

The ironic thing is there are definitive tests for CMT
(genetic) and tests measuring impairment (EMG, Nerve Conduction). So far the
assessors have not been interested in seeing those tests. There is no
definitive test for MS, yet those athletes seem to have ready acceptance. MS
symptoms can accelerate or go into remission. There are treatments to slow
progression. That is not the case with CMT, my disease progresses every day.

It was a tough decision but I switched to the age group
race. My heart is really in racing as a Para-athlete, but the uncertainty of
the classification system sealed the deal for me.

If I had raced Para, I would have been the Open Division
Women’s champion, because I would have been the only one racing. It was tough to see the athletes get their
medals and a standing ovation.

I ended up finishing 8th out of 13 women and
punched my ticket to Spain. I raced as
hard as I could so I would feel I had earned it. I traded a spot on the podium
for a spot on the team.

When I was not allowed to compete as a classified athlete in
Austin this May, the Para-triathlon Manager tried to console me by telling me I
was still a triathlete and able to compete in the open division. I was angry
and told her I was there to compete for a spot on the U.S. team and to go to
the World Championship.

That has been my goal for the last two years. I trained so
hard for the Par- triathlon Championships the last two years, only to be denied
the chance to compete. This was one race no one could keep me out of.

When I signed up for Age Group Nationals here in Milwaukee,
my coach asked me why. I told her I wanted to have the experience of competing
at that level so I would be ready some day for the World Championships. I always thought it would be as a
para-triathlete.

How ironic that I would
qualify as an age group athlete and it was all so easy. All I had to do was show up and of course
finish the race. So at the end of May I will line up with athletes from around
the world. I will represent my country and gain some valuable experience. I will try one more time the week before to
compete as a Para-triathlete at the National Championship in Austin. So someday if I should qualify for the
Para-triathlon or Para-duathon TRI 3 division, I will have some really valuable
experience at the national and international level.

So once again life is not fair and one more time I’ve gotten
the better end of the bargain. I think I’ll take it.

***************

Chris
Wodke

Founder
& Manager Team CMT

www.run4cmt.com

Team CMT
is a group of athletes and supporters working to raise awareness and to find a cure
for CMT. We have 137 members in 27 states. We also have members in Australia, Canada,
Vietnam, Turkey, Finland
and Iran.
If you wish to join us visit our web site.

CMT or
Charcot-Marie-Tooth is the most commonly inherited peripheral neuropathy. It
affects over 155,000 Americans (as many as MS). It is a disease of the
nerves that control the muscles. It is slowly progressive, causing loss of
normal function and or sensation in the lower legs/feet and arms/hands.

Symptoms
include; muscle wasting in the lower legs and feet leading to foot drop, poor
balance and gait problems Atrophy in the hands causes difficulty with manual
dexterity.

Structural
foot deformities such as high arches and hammer toes are common.

Poor
tolerance for cool or cold temperatures and many people have chronically cold
hands and feet.

Sunday, October 20, 2013

"It's a funny thing, the more I practice , the luckier I get."- Arnold Palmer

Today's blog comes from the USAT book, "Complete Triathlon Guide" The swim leg is the weak link for most triathletes, I know it still is for me. So I spend at least part of every pool workout doing swim drills, some of which are from this book.

The purpose of the drills is to improve your body position and make you a more efficient and hopefully faster swimmer. Being a good swimmer can help your whole race. With good body position you will use less energy and have a better bike and run.

I like drills because they are fun. Swimming lap after lap can be boring and mixing in drills keeps it fun. I start out my swim with about 15 minutes of drills or if I am feeling tired I will alternate the drills with my laps.

First a review of the parts of the swim stoke and then the drills. Try out a few and see if they help.

Five Phases of the Freestyle Stroke

1.Entry
and extension. In this phase, the hand enters the water and
extends forward just under the surface, like putting on a long glove that is
lying just under the surface of the water, parallel to the surface.

2.Elbow
bend or catch. Aft the arm is fully extended, the next phase
involves internally rotating the shoulder and bending the elbow. This prepares
the forearm to be used as a paddle to apply force backward and propel you
forward.

3.Pull. This
is where the force is applied to the water, and the body then moves past the
arm. It can also be termed the power
phase since it is where the majority of the forward power and propulsion come
from in swimming.

4.Round-off and release. When the pull is finished and the triceps
have been used to extend the arm along the side of the body, it is time to
externally rotate the shoulder, which releases the shoulder joint and allows
the arm to move freely to the next phase.

5.Recovery. After
the shoulder is released, the arm can then return back over the water to start
the cycle again by going into the entry and extension phase.

Vertical Kicking Drill

The purpose of this drill is to make the kick efficient and
improve long axis rotation. From a verticalposition with your arms at your sides, use a
flutter kick to keep your head above water. This is the part of the drill where
you work on your kick. You can even look down on your legs and make sure you
are not bending your knees too much or bending forward at the waist. Utilize the upper muscles of the leg, and
make small fast movements. Work your way up to 1 minute.

Advance
Version- From the same vertical kicking position, rotate 90 degrees
every 3 to 5 seconds to work on rotating from the core. Rotate the entire body
as a unit from the kick and hips, 90 degrees to the right and then back to center,
then 90 degrees to the left and back to center again. Repeat this for another
minute, and focus on starting the rotation from the kick and hips, not the
upper body.

Corkscrew Drill

This drill helps you find a balanced and comfortable body
position and improves your long axis rotation.
This is the same drill as vertical kicking, only you move into the
horizontal plane as you progress toward swimming. Keep your hands at your sides, and again
focus on turning the body from your kick and hips; do not lead with the head
and shoulders. For this drill, rotate your body 180 degrees so you are either
on your belly or your back. Keep your head back and hips up to have an aligned
body position on your back. You should be looking either at the ceiling (when
on your back) or at the bottom of the pool (when on your belly). Be sure to take your time, and breathe out
when your head is facing down; when your head is facing up, try to relax and
breathe normally. You can stay on your back or belly as long as you like until
you feel ready to rotate properly.

Kick on Side Drill

Another drill for body position and will help you to have
the right head position when breathing. This side position is one of the most
stream-lined forms a human can take in the water. The objective here is to get
more comfortable with the head lying on the shoulder and having one goggle in
and one out of the water. This is the ideal position for your head when you
breathe.

To do this drill, lie on your side, with your bottom arm
stretched out and your ear pressing onto the shoulder. This arm should be just
under the surface of the water, with the hand parallel to the bottom of the
pool. The top arm should be on your side. Do a
flutter kick, and strive to maintain one goggle in and one goggle out of the
water. The natural tendency is tostart lifting the head
to get the mouth out of the water to breathe. This actually makes you sink and
work harder. If breathing while keeping a good head position is difficult,
simply roll your head and look up to allow your mouth and nose to clear the
water and enable you to breathe.

Kick on Side Drill with One
Stroke

This drill works the body position and also the rotation.
You are again progressing toward swimming whole or regular freestyle. In this
drill, you perform the kick on side drill, as just described, but every 5
seconds or so, you make a recovery with the trailing arm and pull with the
leading arm as you rotate over to the other side. The focus needs to be on
making a smooth rotation and keeping the body in alignment. The best way to do
that is to start the recovery first and stay on your side until your hand
passes your face, then start to bend the elbow of the leading arm; as the
recovering arm enters the water, pull with the other arm and roll over to the
other side. Keep your neck in alignment with your spine (do not lift the head)
as though the long axis is coming out of the top of your head. Repeat over to
the other side. Take your time; at first you may do only one rotation per
length.

Kick on Side Drill with Three
Strokes

This drill also works the body position and rotation in
another step toward full freestyle swimming. This drill is the same as the
previous one-stroke kick on side drill, but this time three strokes are used to
rotate from one side to the other. Really focus on an integrated rotation in
each stroke, driving it with your kick and hips, not the head and shoulders.

Catch-up Drill

This drill is great for working on exchanging one arm for
the other in front of the head, ensuring there is always an arm in front of the
head to glide out on. This makes the body longer, and in general, a longer body
moves faster. Think of the long hull design of a speed boat. In addition, the hands meeting in front of
the head is a great reminder to pull and rotate. If you breathe on both sides,
this drill can balance out your rotation. You continue to glide out on the arm
in front as you recover with the other arm. When both arms are fully extended
in front of your head, you then pull with the opposing arm. When first doing
this drill, it is helpful to keep both arms in front of your head and kick
awhile before switching arms. This gives you time to visualize a good pull with
early elbow bending and good rotation during the power phase. As with all
drills, take your time. The slower and more accurately you do these drills, the
more you will retain when you swim fast.

Fist Drill

This drill will specifically help you develop the early
elbow bend at the beginning of your stroke. Many swimmers get little to no
benefit from this drill because they lack the knowledge of how to perform it
correctly. It must be done slowly and with very conscious thought about feeling
pressure on your forearm as you begin your pull. This feedback shows you are
indeed bending the elbow early enough to feel pressure on your forearm as you
pull against the water. What this drill does is take the hand out of the pull.
In a sense this forces you to bend the elbow to try to “catch” some water. If
you rush the strokes, you will simply make the same errors you make in regular
swimming. Never do an entire length with
fists. The dynamic feeling of opening the hands and feeling the added power
from the higher elbow is the positive feedback that makes the change carry over
to your regular stroke. Since you actually do need to struggle though the water
a bit to feel this pressure on your forearm, it is be to do this drill without
fins.

Sculling Drill

This is another drill for working on the beginning of your
pull. Sculling is defined as moving a limb from side to side to create lift. It
is the motion one uses for treading water. This subtle skill can be helpful in
getting that elusive “feel” for the water swimmers talk about. The goal is to
get a feeling of pressure on your arm from the fingertips to your elbow. To do
this, push off and bend both arms at the elbows, and rotate your shoulders
medially so your fingertips face the bottom of the pool. Then as though your
forearm and hand form a paddle, hinge at the elbow and wave your hand and
forearm in and out repeatedly for 3 to 5 seconds. Then swim normally and take a
few breathes; when ready repeat. While sculling, be sure to keep your neck
neutral, and hence breathe only when you are taking the regular strokes between
sculling.

Single-Arm-Drill

The purpose of this drill is to make the swimmer focus on
only on arm at a time. To perform this drill, use only your right arm to swim
one length and then your left to swim the next. This drill is used to work all
five phases of the freestyle stroke. It can be tricky because many swimmers try
to work on all five phases at once, where noting is really worked on
specifically, and a swimmer can end up make the same mistakes in the drill as
in their regular swimming. However, if you focus on only one aspect or phase
for an entire two length sequence the results are amazing. When in doubt as to
which phase to focus on, the early elbow ben at the beginning of the pull is
your best choice best choice because problem in this phase are very common, and
every swimmer can benefit from improving it. If you your swimming analyzed on
video and you can see in your mind’s eye other flaws to
correct, such as poor entry or recovery, then do another two length sequence
focusing on just that phase.

Catch-up Drill with Thumb
Scrape

This drill will ensure you finish each stroke. Before you
push off, extend your arm down your leg, and scrape your thumb on your thigh.
At the finish of each pull, scrape your thigh in the same area. This is also
the perfect drill to work on the release of the shoulder at the end of your
stroke since with the touch you are sensitized to that part of the stroke.

Catch-up Drill With Fingertip
Drag

This twist on the catch-up drill focuses on the recovery and
entry of your stroke. For this drill, lie on your side and slowly drag your
fingertips through the water’s surface as you recover. Ideally, you should see
the palm of your hand as it passes about 8 to 12 inches from the side of your
head. Your fingertips stay in the water from the release phase of the stroke
until the hand enters the water. After
entry, the arm extends in front of the shoulder to full extension and meets the
other outstretched arm.

**************************

Chris
Wodke

Founder
& Manager Team CMT

www.run4cmt.com

Team CMT
is a group of athletes and supporters working to raise awareness and to find a cure
for CMT. We have 137 members in 27 states. We also have members in Canada, Vietnam,
Turkey, Finland and Iran. If you wish to join us visit
our web site.

CMT or
Charcot-Marie-Tooth is the most commonly inherited peripheral neuropathy. It
affects over 155,000 Americans (as many as MS). It is a disease of the
nerves that control the muscles. It is slowly progressive, causing loss of
normal function and or sensation in the lower legs/feet and arms/hands.

Symptoms
include; muscle wasting in the lower legs and feet leading to foot drop, poor
balance and gait problems Atrophy in the hands causes difficulty with manual
dexterity.

Structural
foot deformities such as high arches and hammer toes are common.

Poor
tolerance for cool or cold temperatures and many people have chronically cold
hands and feet.

Sunday, October 13, 2013

I am really more of a big picture person. I don't much like detail. This weekend I had to be detail oriented because I spent most of the weekend proofreading.

The picture shows the proof copy of my book. It is hard to believe I have actually written a book and it is only a few weeks from publication.

It seems kind of weird to be an author. A couple of weeks ago I got an invite from my publishing house for a meet and greet with other authors. Other people write books. Well I used to think I would never run the Boston Marathon or compete at a National Championship, but I did that too! I guess I really am an author too!
Sometimes I don't even recognized myself anymore. I am just an ordinary person. I've lived a pretty average life. Sometimes when I read through the book the words seem like someone they were written by another person. Yet here I am looking back at two Boston runs and two National Championship competitions. It all seems like it happened to someone else.

I found a few things to fix in the book including a missing chapter. Added the asked for pictures and have the book all ready to hand back to my editor. As I read through the manuscript at times it seemed like it had been written by someone else. I never expected to have my picture on the cover of a book I had written. It just shows you what an average person can do when they find a mission and a purpose for their life.

I have not been writing much on my blog since my race in Austin last May. Instead of writing my blog I have been working on the book you see pictured. I have been putting it together since Boston actually. I wrote all during both Boston runs and those writing formed the basis for the book. I knew running Boston and the events surrounding this last Boston gave me a perfect chance to tell the story of those affected by CMT.

Here is the dedication from the book, to give you a taste of what is to come and give you an idea of why I put this book together;

Dedication

“I run because I can, when I get tired I remember those who can’t run, what
they would give to have this simple gift I take for grated and I run harder for
them, I know they would do the same for me.”- unknown

This
book is dedicated to the members of Team CMT especially those affected with
CMT.

Thank
you for your courage and determination to be athletes in spite of the
challenges you face. You inspire me.
Thank you to those on the team who joined to support affected friends
and family members. Your love and support mean more than you will ever know.

This
book is also for the 155,000 Americans and 2.6 million people world wide
affected by CMT. This book was written to give you a voice and to put a face to
CMT.

Team
CMT members, walk, swim, run, and cycle for those who can’t to raise awareness
and to funds for research to find treatments and a cure.

Thank
you to our partner the Hereditary Neuropathy Foundation. In HNF President Allison Moore, we found a
supporter, friend and fellow athlete.

I
am forever grateful to the HNF and our team members for their support and
commitment to our mission to raise awareness of Charcot-Marie-Tooth and to
educate the public on the challenges those affected by CMT face.

Just a taste of what will become the book in a few short weeks. Almost at the finish line now!

*********************

Chris
Wodke

Founder
& Manager Team CMT

www.run4cmt.com

Team CMT
is a group of athletes and supporters working to raise awareness and to find a
cure for CMT. We have 137 members in 27 states. We also have members in Australia, Canada, Vietnam,
Turkey, Finland and Iran. If you wish to join us visit
our web site.

CMT or
Charcot-Marie-Tooth is the most commonly inherited peripheral neuropathy. It
affects over 155,000 Americans (as many as MS). It is a disease of the
nerves that control the muscles. It is slowly progressive, causing loss of
normal function and or sensation in the lower legs/feet and arms/hands.

Symptoms
include; muscle wasting in the lower legs and feet leading to foot drop, poor
balance and gait problems Atrophy in the hands causes difficulty with manual
dexterity.

Structural
foot deformities such as high arches and hammer toes are common.

Poor
tolerance for cool or cold temperatures and many people have chronically cold
hands and feet.

Sunday, October 6, 2013

"Never underestimate the power of dreams and the influence of the human spirit. We are all the same in this notion; The potential for greatness lives within each of us." Wilma Rudolph

Sometimes life isn't fair. Today was one of those days, but in a good way. I had a really incredible weekend as a volunteer and a runner.

I know as an athlete how important volunteers are to the success of a race. You can't have a race without them. When you see your friends on the course volunteering like my triathlon friends, Anne, Mary, John and Del Lynn pictured here, it makes for a great race. There is nothing like having fellow athletes cheer for you when they work the course as volunteers.

This weekend was my turn to help out. This weekend was Lakefront Marathon here in Milwaukee. It is where I ran my first and best marathon in 1996. I missed qualifying for Boston that year by only 10 minutes.

I've also volunteered for this race at packet pick up and at the finish line.

Packet Pick-up
Saturday I was scheduled for packet pick up at the race Expo. Packet pick up is an easy job, you check ID, hand out race shirts, goodie bags and answer question. You have to not mind giving the same speech to countless runners about checking their timing chips and luggage rules. Three of the people I worked with were running on Sunday. That is why runner are so great. The day before their own big race and they are on their feet volunteering. One of the volunteers is running Marine Corp in three weeks are part of a team raising money to modify homes for disabled veterans. His 100 person team has raised $76,000. Would I love to harness that kind of fundraising power for my cause. We had a great time talking about races we have done, both marathons and triathlons. I thought about how lucky I was to be running and part of the running community.

Community/Unity Run-Kids Run
My tri coach Scott Stauske had organized a community run run of 2.6 miles to raise money for Girls on the Run and the Milwaukee Police Endurance Association. Both groups work to get kids active and involved in running. Both groups had sponsored a kids program where the kids would run the equivalent of a marathon over the training program. Both runs would finish at the Marathon course finish line.
I almost skipped the race because my knee and ankle are both bothering me and well sometimes I am lazy. I knew my friends Mary, Ann and Del Lynn would be running, so I had to be there. Plus Del Lynn's daughter was running. The adult run was up first, then we would wait and cheer for the kids as they came through a few minutes later.

It was a perfect cool crisp fall morning. I had fun running with my friend Mary. We pushed each other and had a great run. Ann was well ahead of us and Del Lynn was just behind us.

Then we waited for the kids. It was so much fun to see them finish and see how excited their families were. Some of the kids really took it seriously. It was exciting to see future runners cross the finish line. I had a great run and I thought about how lucky I am to be a runner and how good the race felt. It was even better I got to share it with friends.

Marathon Finish
I am not sure how I do it, but I always manage to get myself assigned to the finish line. My first year I did first aid triage, another couple of years I handed out finisher medals. This year I was part of the Mylar blanket brigade.

I so clearly remember how I felt when I crossed the finish line of my first marathon. I was not sure I could actually do it. I trained so hard for it and when I crossed that finish line I felt there was nothing I couldn't do.

I saw that same feeling played out hundreds of times today. Some runners were utterly exhausted. Some had a slight smile of disbelief. Some had tears and I would get choked up too. My fellow blanket brigade stood there handing out blankets. We laughed with runners, we got emotional, we gave countless hugs and celebrated with every finisher. We even got to witness a marriage proposal. So many runners thanked us and I thanked them for running. Because although I stood for hours handing out blankets, the runners made it possible for me to be there. I got much more back than I gave, it just doesn't seem fair.

Running a marathon can be a life changing event. Everyone of those runners has a story and I got to be a little part of it. I saw greatness over and over. I got to see two team members cross the line, a ski patrol friend ran her first marathon. A co-worker running his first marathon qualified for Boston. I saw elite runners turn in impressive performances and I saw the small victories of everyday runners conquering the marathon distance. For a few hours of standing yesterday and today I got to be a small part of that experience. I hope I helped to make it a memorable.

As things got quieter toward the end I looked at the crowd of finishers in the athlete area and I thought back to Boston. I thought about how vulnerable we all are and were today standing at the finish line. I thought about the best I saw today from my fellow runners and volunteers.

I am so proud to be part of the running community here in Milwaukee and will be proud to be an athlete in Boston again this year. Once again the people of Boston will give me more as an athlete then I will give by running that race. They will stand and cheer for hours and cheer for me like I am an elite athlete. Sometimes life is not fair, but I wouldn't have it any other way.

*******************

Chris
Wodke

Founder
& Manager Team CMT

www.run4cmt.com

Team CMT
is a group of athletes and supporters working to raise awareness and to find a
cure for CMT. We have 127 members in 27 states. We also have members in Canada, Vietnam,
Turkey, Finland and Iran. If you wish to join us visit
our web site.

CMT or
Charcot-Marie-Tooth is the most commonly inherited peripheral neuropathy. It
affects over 155,000 Americans (as many as MS). It is a disease of the
nerves that control the muscles. It is slowly progressive, causing loss of
normal function and or sensation in the lower legs/feet and arms/hands.

Symptoms
include; muscle wasting in the lower legs and feet leading to foot drop, poor
balance and gait problems Atrophy in the hands causes difficulty with manual
dexterity.

Structural
foot deformities such as high arches and hammer toes are common.

Poor
tolerance for cool or cold temperatures and many people have chronically cold
hands and feet.